Provider Demographics
NPI:1932616281
Name:RSI PHYSICAL MEDICINE AND PERFORMANCE CARE, INC.
Entity type:Organization
Organization Name:RSI PHYSICAL MEDICINE AND PERFORMANCE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-270-2673
Mailing Address - Street 1:10475 CENTURION PKWY N STE 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5004
Mailing Address - Country:US
Mailing Address - Phone:904-270-2673
Mailing Address - Fax:904-212-0024
Practice Address - Street 1:10475 CENTURION PKWY N STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5004
Practice Address - Country:US
Practice Address - Phone:904-270-2673
Practice Address - Fax:904-212-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8750111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty